Last month APA praised Reps. Benjamin Cardin (D-Md.) and Jim Ramstad (R-Minn.) for co-sponsoring legislation that would reverse the exclusion of benzodiazepine medications from reimbursement under the new Medicare Part D drug benefit.

"Your legislation is timely and most welcome, and the members of APA—and most importantly their patients—are deeply grateful for your leadership," wrote APA President Steven Sharfstein, M.D., in letters to Cardin and Ramstad. "We look forward to working with both co-sponsors on quick enactment of this most important bill."

Nicholas Meyers, director APA's Department of Government Relations, told Psychiatric News, "We intend to do everything we can to highlight the importance of passing the bill as a remedy to a provision in Part D law that makes no sense from a health-policy perspective, and we commend Reps. Cardin and Ramstad for their legislation."

The Medicare Modernization Act of 2003 (MMA) contained language that required that benzodiazepines be excluded from coverage by the new drug benefit, which begins January 1, 2006 (Psychiatric News, February 4). Benzodiazepines are one of nine categories of medications excluded from the list of medications that prescription drug plans will be required to cover under the Part D benefit.

The blanket exclusion of benzodiazepines under the MMA could lead to serious negative consequences for the physical and mental health of millions of individuals to be covered by the new benefit. The exclusion could be particularly troubling for the estimated 1.7 million dual-eligible patients who have been prescribed benzodiazepines as a covered benefit under Medicaid. If coverage ceases on January 1, 2006, these patients, who have been covered by both Medicare and Medicaid, are unlikely to be able to afford to pay for the medications out of pocket—even though the majority of benzodiazepines are available as generics.

Abruptly ceasing benzodiazepines, particularly for those patients who have been taking them for an extended period, can lead to a potentially severe withdrawal syndrome, including seizures. Patients would need to be slowly tapered off of benzodiazepines and switched to something else— a process that often takes months.

Psychiatrist Stevan Gressitt, M.D., founder of the Maine Benzodiazepine Study Group, told Psychiatric News during an interview for a previous article, "The alternatives really are grim. If these patients don't have access to benzodiazepines after January 2006, then they will most likely be switched to something that is covered—an SSRI or an atypical antipsychotic. Neither one of those would be my first choice for an elderly or disabled patient with multiple medical problems who is probably taking several other medications."

The Centers for Medicare and Medicaid Services (CMS) earlier this year issued guidelines that clarified that Medicare drug plans could cover benzodiazepines as part of a supplemental coverage option but not under core Part D benefits.

In addition, CMS said, states could continue to cover the drugs under Medicaid. However, both options would require states to develop and implement legislative authority and administrative procedures to allow the alternative coverage and would have to fund the coverage out of state monies, not Medicare Part D funds.

APA, in a press release on the introduction of the Cardin/Ramstad bill, acknowledged these options, saying, "While [they are] helpful, these options nonetheless create administrative problems and represent, at best, an incomplete solution."

The bill introduced by Cardin and Ramstad (HR 3151) would remove only the exclusion of benzodiazepines, not any of the other classes of excluded medications.

The bill further calls on the secretary of Health and Human Services to contract with "Medicare quality improvement organizations" for the development of "appropriate educational guidelines for physicians regarding the prescribing of benzodiazepines."

APA is assisting in the effort to find sponsors for an identical bill in the Senate, Meyers said.

The text of HR 3151 can be accessed at<http://thomas.loc.gov/> by searching on the bill number. APA's press release is posted at<www.psych.org/news_room/press_releases/05-41CardinRamstad07012005.pdf>.▪